Abstract
Malignant pleural mesothelioma (MPM) is an aggressive neoplasia with a poor prognosis. The optimal treatment of MPM is still a matter of debate and yet today there is no effective therapy for this tumor. Multimodality treatments, including the association of induction and/or adjuvant therapeutic regimens with surgery, have been reported to give encouraging results.
The aim of surgical approach is to obtain a maximal cytoreduction and/or to control the symptoms, however its curative role/potential is still controversial in the management of this neoplasia. Surgical options include extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D).
Today it is well known that multimodality therapy offers acceptable outcomes, with better results reported for trimodality treatment, even though each therapeutic option has some specific advantages and drawbacks that should be taken into consideration.
Individualization of care for each patient is mandatory in choosing the most appropriate treatment to minimize the complications and to maximize the benefits.
The aim of this chapter is to give an overview on the current state of multimodality treatment in MPM.
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References
Moolgavkar SH, Meza R, Turim J. Pleural and peritoneal mesothelioma in SEER: age effects and temporal trends, 1973–2005. Cancer Causes Control. 2009;20:935–44.
Zucali PA, De Vincenzo F, Simonelli M, et al. Future developments in the management of malignant pleural mesothelioma. Expert Rev Anticancer Ther. 2009;9:453–67.
Sugarbaker DJ. Macroscopic complete resection: the goal of primary surgery in multimodality therapy for pleural mesothelioma. J Thorac Oncol. 2006;1:175–6.
Treasure T. What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice. J Thorac Cardiovasc Surg. 2016;151:307–9.
Spaggiari L, Marulli G, Bovolato P, et al. Extrapleural pneumonectomy for malignant mesothelioma: an Italian multicenter retrospective study. Ann Thorac Surg. 2014;97:1859–65.
Rusch V, Baldini EH, Bueono R, et al. The role of cytoreduction in the treatment of malignant pleural mesothelioma: meeting summary of the international mesothelioma interest group congress, September 11–14, 2012, Boston, Mass. J Thorac Cardiovasc Surg. 2013;145:909–10.
Sugarbaker DJ, Flores RM, Jaklitsch MT, et al. Resection margins, extrapleural nodal status and cell type determine post-operative long term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg. 1999;117:54–63.
Rusch VW, Giroux D, Kennedy C, et al. Initial analysis of the International Association for the Study of Lung Cancer mesothelioma database. J Thorac Oncol. 2012;7:1631–9.
Scherpereel A, Astoul P, Baas P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgery for the management of malignant pleural mesothelioma. Eur Respir J. 2010;35:479–95.
Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg. 2004;128:138–46.
Martini N, Bains MS, Beattie EJ Jr. Indications for pleurectomy in malignant effusion. Cancer. 1975;35:734–8.
Cao C, Tian DH, Pataky KA, et al. Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma. Lung Cancer. 2013;81:39–27.
Rice D, Rusch V, Pass H, et al. Recommendation for uniform definitions of surgical techniques for malignant pleural mesothelioma. A consensus report of the International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group. J Thorac Oncol. 2011;6:1304–12.
Butchart EG, Ashcroft T, Barnsley WC, et al. Pleuropneumonectomy in the management of diffuse pleural mesothelioma of the pleura. Experience with 29 patients. Thorax. 1976;31:15–24.
Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complication after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg. 2004;128:138–46.
Weder W, Stahel RA, Bernhard J, et al. Multicenter trial of neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. Ann Oncol. 2007;18:1196–202.
Treasure T, Internullo E, Fiorentino F, et al. A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the society of Thoracic Surgeons (STS). Interact Cardiovasc Thorac Surg. 2011;12:341–6.
Treasure T, Lang-lazdunski L, Waller D, et al. Extrapleural pneumonectomy versus no extrapleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomized feasibility study. Lancet Oncol. 2011;12:763–72.
Wanebo HJ, Martini N, Melamed MR, et al. Pleural mesothelioma. Cancer. 1976;38:2481–8.
Lim EM. MARS 2: a feasibility study comparing (extended) pleurectomy decortication versus no pleurectomy decortication in patients with malignant pleural mesothelioma (MARS2). http://www.clinicaltrials.gov/show/NCT02040272.
Teh E, Fiorentino F, Tan C, et al. A systematic review of lung sparing extirpative surgery for pleural mesothelioma. J R Soc Med. 2011;104:69–80.
Friedberg JS, Culligan MJ, Mick R, et al. Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2012;93:1658–67.
Flores RM. The mesothelioma surgery shift. J Thorac Cardiovasc Surg. 2016;151:485–6.
Flores RM, Pass HI, Seshan VE, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg. 2008;135:620–6.
Lang-Lazdunski L, Bille A, Belcher E, et al. Pleurectomy/decortication, hypertermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy in patients with malignant pleural mesothelioma. J Thorac Oncol. 2011;6:1746–52.
Bolukbas S, Manegold C, Eberlein M, et al. Survival after trimodality therapy for malignant pleural mesothelioma: radical pleurectomy, chemotherapy with cisplatin/pemetrexed and radiotherapy. Lung Cancer. 2011;71:75–8.
Nakas A, Trousse DS, Martin-Ucar AE, et al. Open lung sparing surgery for malignant pleural mesothelioma: the benefits of a radical approach within multimodality therapy. Eur J Cardiothorac Surg. 2008;34:886–91.
Flores RM. Surgical options in malignant pleural mesothelioma: extrapleural pneumonectomy or pleurectomy/decortication. Semin Thorac Cardiovasc Surg. 2009;21:149–53.
Sugarbaker DJ, Wolf AS, Chirieac LR, et al. Surgery for malignant pleural mesothelioma. Expert Rev Respir Med. 2010;4:363–72.
Singhal S, Kaiser LR. Malignant pleural mesothelioma: options for management. Surg Clin N Am. 2002;82:797–831.
Berghmans T, Paesmans M, Lalami Y, et al. Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of literature with meta-analysis. Lung Cancer. 2002;38:111–21.
Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–44.
Zalcman M, Mazieres J, Greiller L, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomized controlled open-label, phase 3 trial. Lancet. 2016;387:1405–14.
Rusch VW. Pemetrexed and cisplatin for malignant pleural mesothelioma: a new standard of care? J Clin Oncol. 2002;21:2696–30.
Marulli G, Rea F, Nicotra S, et al. Effect of induction chemotherapy on lung function and exercise capacity in patients affected by malignant pleural mesothelioma. Eur J Cardiothorac Surg. 2010;37:1464–9.
Buduhan G, Menon S, Aye R, et al. Trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2009;88:870–5.
Weder W, Ketenholz P, Taverna C, et al. Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. J Clin Oncol. 2004;22:3451–7.
Lang-Lazdunski L, Bille A, Lal R, et al. Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma. J Thorac Oncol. 2012;7:737–47.
Okada M, Mimura T, Ohbayashi C, et al. Radical surgery for malignant pleural mesothelioma: results and prognosis. Interact Cardiovasc Thorac Surg. 2008;7:102–6.
Rena O, Casadio C. Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure. Lung Cancer. 2012;77:151–5.
Trousse DS, Avaro JP, D’Journo XB, et al. Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies. Eur J Cardiothorac Surg. 2009;36:759–63.
Bech C, Sorensen JB. Chemotherapy induced pathologic complete response in malignant pleural mesothelioma: a review and case report. J Thorac Oncol. 2010;5:735–40.
Hasegawa S, Okada M, Tanaka F, et al. Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial). Int J Clin Oncol. 2016;21:523–30.
De Perrot M, Feld R, Cho BC, et al. Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Clin Oncol. 2009;27:1413–8.
Krug LM, Pass HI, Rusch VW, et al. Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol. 2009;27:3007–13.
Pasello G, Marulli G, Polo V, et al. Pemetrexed plus carboplatin or cisplatin as neoadjuvant treatment of operable malignant pleural mesothelioma (MPM). Anticancer Res. 2012;32:5393–400.
Van Schil PE, Baas P, Gaafar R, et al. Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial. Eur Respir J. 2010;36:1362–9.
Rea F, Favaretto A, Marulli G, et al. Phase II trial of neaodjuvant pemetrexed plus cisplatin followed by surgery and radiation in the treatment of pleural mesothelioma. BMC Cancer. 2013;13:22.
Flores RM, Krug LM, Rosenzweig KE, et al. Induction chemotherapy, extrapleural pneumonectomy and postoperative high-dose radiotherapy for locally advanced malignant pleural mesothelioma: a phase II trial. J Thorac Oncol. 2006;1:289–95.
Bille A, Belcher E, Raubenheimer H, et al. Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy’s and St Thomas’ hospital. Gen Thorac Cardiovasc Surg. 2012;60:289–96.
Rea F, Marulli G, Bortolotti L, et al. Induction chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant hemi-thoracic radiation in malignant pleural mesothelioma (MPM): feasibility and results. Lung Cancer. 2007;57:89–95.
Bece A, Tin MM, Martin D, et al. Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: toxicity and outcomes at an Australian institution. J Med Imaging Radiat Oncol. 2015;59:355–62.
Chance WW, Rice DC, Allen PK, et al. Hemithoracic intensity modulated radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma: toxicity, patterns of failure, and a matched survival analysis. Int J Radiat Oncol Biol Phys. 2015;91:149–56.
Thieke C, Nicolay NH, Sterzing F, et al. Long-term results in malignant pleural mesothelioma treated with neoadjuvant chemotherapy, extrapleural pneumonectomy and intensity modulated radiotherapy. Radiat Oncol. 2015;10:267.
Rusch VW, Rosenzweig K, Venkatraman E, et al. A phase II trial of surgical resection and adjuvant high dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2001;122:788–95.
Gupta V, Mychalczak B, Krug LM, et al. Hemithoracic radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2005;63:1045–52.
Lee TT, Everett DL, Shu HG, et al. Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2002;124:1183–9.
Allen AM, Czerminska M, Janne PA, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys. 2006;65(3):640–5.
Rimner A, Zauderer MJ, Gomez DR, et al. Phase II study of hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) as part of lung sparing multimodality therapy in patients with malignant pleural mesothelioma. J Clin Oncol. 2010;5:735–40.
Gomez DR, Hong DS, Allen PK, et al. Patterns of failure, toxicity and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma. J Thorac Oncol. 2013;8:238–45.
Rice DC, Stevens CW, Correa AM, et al. Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2007;84:1685–93.
Yajnik S, Rosenzweig KE, Mychalczak B, et al. Hemithoracic radiation after extrapleural pneumonectomy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys. 2003;56:1319–26.
Gupta V, Krug LM, Laser B, et al. Patterns of local and nodal failure in malignant pleural mesothelioma after extrapleural pneumonectomy and photon-electron radiotherapy. J Thorac Oncol. 2009;4:746–50.
Cho BC, Feld R, Leighl N, et al. A feasibility study evaluating surgery for mesothelioma after radiation therapy: the “SMART” approach for resectable malignant pleural mesothelioma. J Thorac Oncol. 2014;9:397–402.
Minatel E, Trovo M, Bearz A, et al. Radical radiation therapy after lung-sparing surgery for malignant pleural mesothelioma: survival, pattern of failure and prognostic factor. Int J Radiat Oncol Biol Phys. 2015;93:606–13.
Baldini EH, Richards WG, Gill RR, et al. Updated patterns of failure after multimodality therapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2015;149:1374–81.
Lang-Lazdunski L, Bille A, Papa S, et al. Pleurectomy/decortication, hypertermic pleural lavage with povidone-iodine, prophylactic radiotherapy and systemic chemotherapy in patient with malignant pleural mesothelioma: a 10-year experience. J Thorac Cardiovasc Surg. 2015;149:558–65.
Sugarbaker PH, Stuart OA, Eger C. Pharmacokinetics of hypertermic intrathoracic chemotherapy following pleurectomy and decortication. Gastroenterol Res Pract. 2012;2012:471205.
Bedirhan MA, Cansever L, Demir A, et al. Which type of surgery should become the preferred procedure for malignant pleural mesothelioma: extrapleural pneumonectomy or extendend pleurectomy? J Thorac Dis. 2013;5:446–54.
Friedberg JS, Simone CB, Culligan MJ 2nd, et al. Extended pleurectomy-decortication-based treatment for advanced stage epithelial mesothelioma yielding a median survival of nearly three years. Ann Thorac Surg. 2017;103:912–9.
Nakas A, von Meyenfeldt E, Lau K, et al. Long-term results after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group stage T3-T4) non-sarcomatoid malignant pleural mesothelioma. Eur J Cardiothorac Surg. 2012;41:1031–6.
Patel PR, Yoo S, Broadwater G, et al. Effect of increasing experience on dosimetric and clinical outcomes in the management of malignant pleural mesothelioma with intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2012;83:362–8.
Tonoli S, Vitali P, Scotti V, et al. Adjuvant radiotherapy after extra-pleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series. Radiother Oncol. 2011;101:311–5.
Luckraz H, Rahman M, Patel N, et al. Three decades of experience in the surgical multi-modality management of pleural mesothelioma. Eur J Cardiothorac Surg. 2010;37:552–6.
Tilleman TR, Richards WG, Zellos L, et al. Extrapleural pneumonectomy followed by intracavitary intraoperative hypertermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg. 2009;138:405–11.
Yan TD, Boyer M, Tin MM, et al. Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors. J Thorac Cardiovasc Surg. 2009;138:619–24.
Miles EF, Larrier NA, Kelsey CR, et al. Intensity modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys. 2008;71:1143–50.
Van Sandick JW, Kappers I, Baas P, et al. Surgical treatment in the management of malignant pleural mesothelioma: a single institution’s experience. Ann Surg Oncol. 2008;15:1757–64.
Allen AM, Den R, Wong JS, et al. Influence of radiotherapy technique and dose on patterns of failure for mesothelioma patients after extrapleural pneumonectomy. Int J Radiat Oncol Biol Phys. 2007;68:1366–74.
Lucchi M, Chella A, Melfi F, et al. A phase II study of intrapleural immune-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II-III malignant pleural mesothelioma. Eur J Cardiothorac Surg. 2007;31:529–35.
Averbach AM, Sugarbaker PH. Peritoneal mesothelioma: treatment approach based on natural history. Cancer Treat Res. 1996;81:193–211.
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Rea, F., Faccioli, E., Marulli, G. (2019). Surgery and Multimodality Treatment in Malignant Pleural Mesothelioma. In: Ceresoli, G., Bombardieri, E., D'Incalci, M. (eds) Mesothelioma. Springer, Cham. https://doi.org/10.1007/978-3-030-16884-1_13
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